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Some epidemiological aspects of perinatal gastrointestinal disease
Linköping University, Department of Molecular and Clinical Medicine, Pediatrics. Linköping University, Faculty of Health Sciences.
2001 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [sv]

[Respondenten]

Hör upp alla männ'skor t trakten.

Ni är bjudna att delta i spikningsakten.

Nu vill jag er informera

och min avhandling summera.

Sex studier av skilda slag,

en restumé i form av vers, inget föredrag.

Studie ett till fem bygger på barn i tusental,

cirka tio, födda nittisju, nittiåtta eller nittnio.

(Förutsatt förstås att deras mor har haft sitt härbärge,

Någonstans uti sydöstra Sverige.)

Låt oss gå från helhet till detalj,

och följa en genomsnittsfamilj, en ömsint kvmna och en kanalj.

Akt I Förlossningssalen.

[Barnet] Efter graviditeten fyrti veckor lång

börjar jordelivet efter passage så fasligt trång.

Där står pappa glad och ler

mot mor och mig, [Far] -Åh, vad jag älskar er!

[Far] Men nu kära mor är det dags att fylla i enkäten(!),

hur du har haft det under "graviditäten".

Har du och jag nå'n sjukdom, kanske "gluten"?

(undrar barnets far, den långe drasuten)

(Mor] Gluten, nu har jag änligen fått kläm

på varför vårt barn vägde mindre än "två och fem"!

Även om du varit noga med aptiten,

är det nog tarminflammationen din som gjort'en liten!

[Far] (Pekar på mor) En annan orsak kan vara böldema dina l tarme,

[Mor] liten av ulcerös koliten, å gud forbarme!

[Far] och säger far, att sonen fötts för tidigt, var det gastroenteriten?

Du Vet i fjärde måna'n hade du problem med "skiten"!

[Mor] Men sonen var blott tidig med en enda da'?!

[Far] Men det var ju det han Ludvigsson sa!

Akt II Förlossningssalen. Barnmorska gör entré.

[Barnmorska] Ligg ner kära mor, ni är blek som ett lärft!

Det är även barnet, kan det vara något han ärvt? (Väntar inte på svar, vänder sig till mor)

Att ha ont, att må illa är snarast kutym.

[Mor] Tack jag mår bra men hur är det med antikroppsmängd mot transglutaminas-enzym?

[Barnmorska] Det är svårt att säga, men den kanske växlar under loppet av ett år, jag tror Ludvigsson fått upp ett spår!

[Respondenten]

Då lämnar vi patient, barn, far och barnmorskeintendenten.

Det var allt för denna gång från den unge respondenten.

Place, publisher, year, edition, pages
Linköping: Linköping University Electronic Press, 2001. , 104 p.
Series
Linköping University Medical Dissertations, ISSN 0345-0082 ; 707
National Category
Medical and Health Sciences
Identifiers
URN: urn:nbn:se:liu:diva-28605Local ID: 13760ISBN: 91-7373-137-4 (print)OAI: oai:DiVA.org:liu-28605DiVA: diva2:249416
Public defence
2001-12-08, Wilandersalen, Universitetssjukhuset, Örebro, 10:00 (Swedish)
Opponent
Available from: 2009-10-09 Created: 2009-10-09 Last updated: 2012-09-04Bibliographically approved
List of papers
1. Coeliac disease in the father affects the newborn
Open this publication in new window or tab >>Coeliac disease in the father affects the newborn
2001 (English)In: Gut, ISSN 0017-5749, E-ISSN 1468-3288, Vol. 49, no 2, 169-175 p.Article in journal (Refereed) Published
Abstract [en]

BACKGROUND AND AIMS Untreated coeliac disease in the mother is associated with lower birth weight. We examined the risk of adverse neonatal outcome when the infant's mother, father, or other relative suffered from known coeliac disease.

METHODS Mothers answered a questionnaire a few days after the birth of their infant. Of a total of 10597 single birth infants from Southeast Sweden, 53 infants had a mother with coeliac disease (father 27, sibling 70, other close relative 442). Adjusted odds ratios and adjusted differences for neonatal outcome were calculated.

RESULTS Infants whose father suffered from coeliac disease had a lower birth weight (95% adjusted confidence interval (CI) −459, −72 g), more often belonged to the low birth weight (LBW) category (LBW ⩽2499 g) (95% CI adjusted odds ratio (AOR) 1.48–17.18), and had a shorter pregnancy duration (95% adjusted CI −1.53, −0.08 weeks) than non-coeliac controls. They also weighed less than infants whose father suffered from other autoimmune diseases (95% CI −549, −93 g). Infants whose mother suffered from coeliac disease had a lower birth weight (95% adjusted CI −370, −74 g) and more often belonged to the LBW category (95% CI AOR 2.60–15.08) than non-coeliac controls. These infants were more often in the LBW category than infants whose mother suffered from non-diabetic autoimmune diseases (95% CI AOR 1.24–9.65). Coeliac disease in other relatives was not associated with any adverse effect on neonatal outcome.

CONCLUSIONS This study suggests that even treated coeliac disease, in either of the parents, has a negative effect on pregnancy, resulting in lower birth weight and perhaps shorter duration of pregnancy.

National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:liu:diva-80924 (URN)10.1136/gut.49.2.169 (DOI)
Available from: 2012-09-04 Created: 2012-09-04 Last updated: 2017-12-07Bibliographically approved
2. Milk consumption during pregnancy and infant birth weight
Open this publication in new window or tab >>Milk consumption during pregnancy and infant birth weight
(English)Manuscript (preprint) (Other academic)
Abstract [en]

Objective To examine birth weight and risk of low birth weight (≤2 499g, LBW) in relation to milk intake.

Design Questionnaire-based study.

Setting Southeast Sweden

Population Single birth infants within the ABIS project included during a two-year period (ABIS = All Babies In Southeast Sweden).

Main outcome measures Birth weight and LBW.

Results Low milk intake during pregnancy was associated with a decrease in infant birth weight (P<0,01l, Kruskal-Wallis) but did not correlate with LBW (P=0.434, Chi-2) (10 489 infants with complete data)

When adjusting for confounders (regression analyses) low milk intake during pregnancy was associated with a decrease in infant birth weight (adjusted P for trend<0,001) and with an increased risk of LBW (adjusted P for trend= 0.028) (9 097 infants with complete data).

Conclusion This study suggests that low milk intake in the pregnant mother is associated with lower birth weight of the newborn. Further research is needed to evaluate the relationship between low milk intake and the risk of LBW.

National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:liu:diva-80925 (URN)
Available from: 2012-09-04 Created: 2012-09-04 Last updated: 2012-09-04Bibliographically approved
3. Gastroenteritis during pregnancy. Effect on neonatal outcome.
Open this publication in new window or tab >>Gastroenteritis during pregnancy. Effect on neonatal outcome.
(English)Manuscript (preprint) (Other academic)
Abstract [en]

Previous studies have shown that gastrointestinal disease in the mother may be a risk factor for low birth weight infants. The author examined the prevalence of gastroenteritis during pregnancy and its effect on neonatal outcome for each gestational month, 10597 singlebirth mother-infant pairs in the ABIS project (All Babies In Southeast Sweden). Mothers with inflammatory bowel disease, celiac disease, lactose intolerance or cow's milk allergy were excluded (remained 10229 mother-infant pairs with data on gastroenteritis). 32.5% of the mothers suffered from gastroentedtis during pregnancy (95% confidence interval 32.5-32.5%), risk factors included young age (P for trend<0,001), previous infants (P<0.001), work in pediatric day-cure (P=0.004) and exposure to life event (P=0.027). Binary logistic and multiple linear regression analyses were adopted for the analyses of neonatal outcome: birth week, preterm birth (<37 weeks), birth weight, Low Birth Weight (≤2499g), birth length, cesarean section and neonatal hospital care. Maternal gastroentetitis during the 4th (-0.18wk; 95% CI=-0.36, -0.01 wk), 5th (-0.30wk; 95% CI= -0.49, -0.11 wk) or 7th (-0.18 wk; 95% Cl= -0.35, -0.01 wk) month of pregnancy was associated with shorter pregnancy duration (adjusted for confounders). Pregnancy gastroenteritis did not affect birth weight or any other neonatal parameter. Gastroentetitis affects a large proportion of pregnant women, with increased dsk for women with frequent child contact. Gastroenteritis duting part of the pregnancy was associated with shortened pregnancy duration, but it had no other adverse effects on neonatal outcome. The reduction in pregnancy duration is probably of little clinical relevance. The findings of this study need to be confirmed in a prospective study.

National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:liu:diva-80926 (URN)
Available from: 2012-09-04 Created: 2012-09-04 Last updated: 2012-09-04Bibliographically approved
4. Inflammatory bowel disease in mother or father and neonatal outcome
Open this publication in new window or tab >>Inflammatory bowel disease in mother or father and neonatal outcome
2002 (English)In: Acta Paediatrica, ISSN 0803-5253, E-ISSN 1651-2227, Vol. 91, no 2, 145-151 p.Article in journal (Refereed) Published
Abstract [en]

Even a minor decrease in birthweight predisposes to adult disease. Inflammatory bowel disease (IBD) in the mother is a risk factor for low birthweight and preterm infants. This study investigated the effect of IBD in the mother or father, adjusting for confounders, on the newborn infant, with the focus on birthweight and pregnancy duration. A total of 10 399 single-birth mother-infant pairs was prospectively enrolled within the ABIS project (All Babies In Southeast Sweden). Outcome measures included birth week, preterm birth (<37 wk), birthweight, low birthweight (<2500 g), birth length, caesarean section and neonatal hospital care. Ulcerative colitis (UC) in the mother was associated with lower birthweight in the infant (adjusted difference:—330 g, adjusted 95% confidence interval:—509 to—150 g, p < 0.001), and with even lower birthweight when the mother was treated with Mesalazine or steroids. No decrease in birthweight was seen in infants whose mother suffered from Crohn's disease (CD) (adjusted difference:—65 g, adjusted 95% confidence interval:—354 to 224 g, p > 0.05). Maternal UC or CD did not affect the pregnancy duration. The neonatal outcome of infants whose father suffered from UC and CD did not differ from the control group.

Conclusion: UC in the mother affects the birthweight of the infant, which may predispose to future disease in the infant. Most women and men with UC and CD can, however, expect a healthy child with neither preterm birth nor low birthweight.

National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:liu:diva-26527 (URN)10.1111/j.1651-2227.2002.tb01686.x (DOI)11087 (Local ID)11087 (Archive number)11087 (OAI)
Available from: 2009-10-08 Created: 2009-10-08 Last updated: 2017-12-13Bibliographically approved
5. Tissue Transglutaminase autoantibodies in cord-blood from children of healthy mothers
Open this publication in new window or tab >>Tissue Transglutaminase autoantibodies in cord-blood from children of healthy mothers
(English)Manuscript (preprint) (Other academic)
Abstract [en]

Background/aims: Detemlination of tissue. transglutaminase autoantibodies (tTGAA) is a sensitive and specific diagnostic tool for large-scale screening for coeliac disease. Early diagnosis and treatment of coeliac disease eliminate gastrointestinal symptoms ru1d reduce the risk of secondmy complications. The purpose of this study was to correlate maternal and infant background factors and their association with tTGAA levels in cord-blood of the ABIS child cohort (ABIS= All Babies In Southeast Sweden).

Methods: 2518 cord-blood samples were screened using immunoprecipitation for autoantibodies against tissue transglutaminase, GAD 65 (Glutamic Acid Decarboxylase) and IA-2 (Tyrosin phosphatase). Data on background factors were obtained from the mothers (questionnaire). Multiple comparisons in our analyses were handled by means of a modified Bonferroni adjustment; thus, P values ≤ 0.0019 (0.05/26) were considered to indicate statistical significance.

Results: 10/2518 (0.40%) were positive for tTGAA (>0.040 Arbitrary Units (AU)). No cord-blood specimen from known coeliac mothers were positive for tTGAA. Neither absolute tTGAA nor positive tTGAA levels (>0.040AU) correlated with the independent variables in our model Seasonal variation in tTGAA levels (P=0.018) did not reach significance when adjusting for multiple comparisons.

Conclusions: TTGAA levels do not seem to be influenced by the environmental or physical factors in our study, but the issue of seasonal variations in tTGAA levels should be further explored.

Keyword
Antibodies, coeliac, foetus, screening
National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:liu:diva-80929 (URN)
Available from: 2012-09-04 Created: 2012-09-04 Last updated: 2012-09-04Bibliographically approved
6. Tissue Transglutaminase Auto-antibodies in Cord Blood from Children to Become Celiacs
Open this publication in new window or tab >>Tissue Transglutaminase Auto-antibodies in Cord Blood from Children to Become Celiacs
2001 (English)In: Scandinavian Journal of Gastroenterology, ISSN 0036-5521, E-ISSN 1502-7708, Vol. 36, no 12, 1279-1283 p.Article in journal (Refereed) Published
Abstract [en]

Background: Determination of tissue transglutaminase auto-antibodies (tTGAA) has been shown to be a sensitive and specific diagnostic tool for large-scale screening for celiac disease. The purpose of this study was to measure tissue tTGAA in cord blood in infants that later developed celiac disease to evaluate if this assay could serve as a predictive tool for later development of celiac disease.

Methods: IgG tTGAA were analyzed in cord blood through immunoprecipitation from 51 future celiac patients and 102 age-matched controls. Cut-off level was set at 0.040.

Results: No difference in tTGAA levels was found between cord blood from infants who later developed celiac disease and controls ( P = 0.746). 2/51 future celiac patients (3.9%) had levels above cut-off-value in cord blood, while 3/102 controls were positive (2.9%) ( P = 1.000). tTGAA levels were higher in the 1980s and at the beginning of the 1990s than they have been in recent years ( P = 0.003).

Conclusions: Determination of tissue tTGAA in cord blood does not predict future celiac disease in children. tTGAA levels vary with time, which should be considered in retrospective studies analyzing tTGAA.

National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:liu:diva-25927 (URN)10.1080/003655201317097128 (DOI)10369 (Local ID)10369 (Archive number)10369 (OAI)
Available from: 2009-10-08 Created: 2009-10-08 Last updated: 2017-12-13Bibliographically approved

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Ludvigsson, Jonas F.

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